Adaptive Hybrid Surgery: Paradigm Shift for Patient-centered Neurosurgery

Area of Science:

• Neurosurgery
• Radiation Oncology
• Oncology

Background:

• Surgical management of cerebral and skull base lesions has advanced, but complete resection of tumors near critical neurovascular structures remains challenging due to high morbidity.
• Stereotactic radiosurgery (SRS) is effective for moderate-sized tumors, offering excellent control and low complication rates.
• Large cerebral and skull base tumors pose a significant management challenge, with radical surgery risking neurological deficits and SRS alone increasing radiation-induced complications.

Purpose of the Study:

• To review and discuss adaptive hybrid surgery (AHS) as a modern, multidisciplinary treatment approach for large cerebral and skull base tumors.
• To evaluate the safety and efficacy of combining planned subtotal resection (STR) with adjuvant SRS.
• To explore the paradigm shift from maximal resection towards a multimodal strategy balancing surgical and radiation benefits.

Main Methods:

• Review of available data and expert views on AHS.
• Discussion of AHS as a multimodal approach combining open microsurgery and SRS.
• Case examples, including vestibular schwannoma (VS), to illustrate AHS principles and outcomes.

Main Results:

• AHS, involving planned STR followed by adjuvant SRS, is gaining interest as a way to decrease surgical morbidity while achieving tumor control.
• This hybrid approach aims to leverage the advantages of both surgical resection and radiosurgery.
• Successful application of AHS requires a thorough understanding of both surgical and SRS modalities and their safety-efficacy profiles.

Conclusions:

• Adaptive hybrid surgery represents a viable, multidisciplinary strategy for managing large cerebral and skull base tumors, offering a balance between maximal tumor removal and minimizing treatment-related complications.
• While intuitive, the adoption of AHS requires a shift in traditional surgical philosophy.
• Further data and discussion are needed to solidify AHS as a standard treatment option, with vestibular schwannoma serving as a key example.